By Dr. Eugenio Ciuccetti
Generality
Urinary incontinence is a condition that today affects about 30% of women and is characterized by the involuntary loss of urine in socially inappropriate moments and places. Such losses, obviously, constitute a significant problem, both from the point of view of hygiene, psychological and relational.
Types of Incontinence
There are several forms of urinary incontinence: stress incontinence, for example, is linked to the increase in intra-abdominal pressure (and therefore to the bladder) when movements and physical efforts are made. Even a sneeze or raising spending may be enough to trigger this mechanism.
Finally, there are forms of mixed incontinence, in which the symptoms of both types described above appear.
Causes and risk factors
In general, women tend to be more affected than men for intrinsic anatomical and constitutive reasons. With the hormonal transformations typical of menopause, for example, some unfavorable changes occur in the bladder, urethra and all the structures involved in urine elimination.
It should be noted, however, that the problem of urinary incontinence frequently affects many young women as well. Consider, for example, the possible traumas and alterations of pelvic support related to pregnancy and childbirth.
Hence, then, the importance of knowing the risk factors: such as obesity, excessive weight gain during gestation, smoking, constipation or heredity.
Prevention in pregnancy
Equally the need for future mothers to properly prepare (with simple exercises and treatments) their perineum during pregnancy, relying on the experience of qualified professionals such as midwives.
It will thus be possible to increase the proprioceptivity of the perineum, correct the imbalances of the lumbo-pelvic statics, tone the activity of the muscles of the elevator of the anus and prevent the possible alterations of urogenital continence.
Different techniques will be used for this, also based on the specific time of pregnancy. From the traditional cat exercise to perineal contractions in a squatting or supine position to some effective relaxation and breathing strategies.
Even after the birth, then, it will be necessary to be cautious. Many women want to recover their physical and aesthetic shape as soon as possible. But overloading the abdominals before having recovered the integrity and tonicity of the perineal muscles could later cause unpleasant surprises.
Pelvic floor rehabilitation
Equally important are any pelvic floor rehabilitation programs now available in various centers in our country. The pelvic floor - to be precise - is the muscle-fascial structure that closes the abdominal-pelvic cavity at the bottom, surrounding and supporting the urethra, the bladder, the vagina up to the anorectal apparatus.
When we talk about rehabilitation we refer to an essentially "conservative" approach to the problem. An approach that often avoids or integrates any surgical or pharmacological interventions.
Rehabilitation can be based on different techniques. For example, the Kinesiotherapy, based on specific exercises able to give the woman the consciousness of her own perineal area (often little known and "felt") and the ability to control and reinforce it.
The so-called Kegel exercises, among other things - by increasing the blood flow to the muscles of this region - have also proved effective in increasing the woman's feelings of pleasure in the genital level.
Further possibilities are then offered by Biofeedback (which, using a specific vaginal probe, helps the subject to correct himself and work correctly with his own perineum) and functional electrical stimulation (a passive technique, based on the use of specific electrodes and relative pulses electrical - absolutely painless - which in turn go to stimulate the pelvic floor muscles).
One does not die of urinary incontinence but certainly the quality of life is profoundly conditioned. Many women tend to "remove" the problem, for little information, for reasons of modesty and embarrassment or judging it to be an inevitable side effect of aging. Incontinence instead can and must be prevented, countered and treated.
